Titlebook: Atlas of endoscopic major pulmonary resections; Dominique Gossot Book 20101st edition Springer-Verlag Paris 2010 Pulmonary lobectomy.Pulmo

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https://doi.org/10.1007/978-3-319-59232-9Although a lingulectomy (S4 + S5) is equivalent to a middle lobectomy with respect to pulmonary function and anatomy, it is actually technically more difficult because of the variable anatomical relationships.

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Endoscopic mediastinal lymph node dissectionThe major pulmonary resections that will be described in the following chapters are mostly done for lung cancer. Surgical treatment of lung carcinoma with curative intent requires complete resection, i.e., microscopically proved free resection margins and systematic nodal dissection. A systematic lymph node dissection means:

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Right upper lobeThe right upper lobectomy is a difficult endoscopic procedure. Difficulties are from several orders. The operative field is large, and the scope has to switch from the anterior to the posterior mediastinum and from the apex to the diaphragm. In addition, the following difficulties may be faced:

Amenable

Middle lobeContrary to other lobectomies, it is usually preferable to divide the middle lobe pulmonary vein at an early stage. Its occlusion does not cause significant venous congestion, and it is the key to access the arteries and the bronchus.

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Right lower lobe: superior segmentResection of the superior segment (S6) of the right lower lobe is reasonably easy, thanks to the constant anatomical landmarks. However, as for a right lower lobectomy, the exposure of the pulmonary artery and its segmental branch can be tedious in case of fused fissure.

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